Advancing the Interests of the Profession in California

By: Mary Riemersma, Former Executive Director

The Therapist
(March/April 2008)

For any person who has been a member of CAMFT for many years, you are aware of the efforts of CAMFT over decades to advance the profession in California. For those who are newcomers to the profession in California or new to membership in CAMFT, you are likely unaware of what the organization has done to assure LMFTs that they have a recognized place in the mental health marketplace in California. But, we never rest on the accomplishments of the past, we continue to be vigilant in all of CAMFT endeavors to move the profession forward. Some may wonder how we (CAMFT) decide on the positions we take that are believed to be in the profession·s best interests. Of course, we have a Board of Directors and staff that debate, deliberate, and determine direction in an effort to set the best policy. These positions are often complicated, complex, and difficult, and often result in sleepless nights for those involved.

But, policy is not made in a vacuum. Our staff leaders speak with a multitude of members each day, developing a keen sense of what is on the minds of members. Our staff and volunteer leadership regularly attend and speak with members of CAMFT Chapters, again becoming aware of what members are thinking. CAMFT regularly engages in surveys and other research, with all members or random samplings of members, to learn about member needs, wants, and desires.

While member views are critically important, we do not stop there. CAMFT is involved in a multitude of other organizations and coalitions where we can experience the views of the public, the views of other disciplines, the views of consumers of mental health services of all kinds, the views of agencies who utilize mental health professionals, the views of schools, the views of a variety of governmental bodies, and others. From these experiences we learn what is meaningful to all of these significant stakeholders.

From consumers, we learn that their main concerns are can professionals (whatever their credentials) help them? We have to remember as well that the most prominent reason that consumers do not seek mental health services is the belief that it will not help, that therapy will not work. Thus, we have to stay fixed on the main goal·making sure that consumers of mental health care are receiving services that are beneficial and they actually believe they have received value for the services provided. Again, the alphabet soup of license designations is not meaningful to most consumers. The philosophy, theoretical orientation, particular training, is of little significance to most consumers·if you don·t believe me, ask them. Being effectively helped is meaningful. Since consumers drive the utilization of mental health services, we would be negligent if we failed to focus on their needs.

The views of other disciplines, of course, have an effect on what we have been able to do to move the profession forward. There was once a commonly held belief that LMFTs were not as well-prepared as the other mental health disciplines. At one time that claim may have been justified. Today, we know the profession is being well-prepared and the level of respect for the profession has dramatically changed; however, we still hear some of these same claims from our competitors, e.g., unions primarily comprised of clinical social workers and psychologists continue to make claims, to protect their ·turf,· that LMFTs do not have the qualifications to hold positions in some sectors like county mental health, the Department of Corrections and Rehabilitation, or the Veterans Administration. These competitive factors obviously influence what we are able to achieve for the profession. Governmental and private agencies have a stake in what we are able to achieve in that they want to provide the services they provide in the most cost effective and efficient way while adhering to the demands that others (usually other governmental bodies) place on them. Because of limited financial resources and often relying upon reimbursement from state and federal payers, we find that because of things like our lack of inclusion in Medicare, LMFTs are not utilized because of the lack of reimbursement from the federal government. This lack of reimbursement has little to do with the qualifications of our profession, but a lot to do with concerns about money·especially tight in the state of California. These public and private agencies are also looking to utilize professionals that understand their system and operation·professionals that know how to work as part of a team, do case management, keep an extensive array of records, share their philosophy, are culturally and linguistically competent, and do all of those things that they must achieve to retain their licensing and contracts.

Then there is also the issue of the license title of the MFT profession, which many find as both a help and a hindrance. Some within the profession believe it is a good title. Some within the profession believe it limits the profession. Sometimes the public misunderstands the title, thinking that the profession solely engages in marriage counseling. While we believe it is an explainable title, the misconceptions must often be overcome. For example, in trying to assure that MFTs will be utilized in the Department of Corrections and Rehabilitation, we often hear, ·MFTs, why MFTs, what do marriage and family therapists, or marriage counselors, have to do with those who are incarcerated?· And, of course, there are good responses to their questions; but they are questions that require repeated explanations.

While certainly professional identity, within all of the professions, is significant to the professionals who choose to follow a particular course, however, professional identity also varies greatly within each profession. When one drills down to what each professional does, we quickly discover that each and every professional within his/her profession is likewise unique and each has his/her own particular identity. While all California licensed marriage and family therapists share the identity of their chosen profession, we find that some identify with being art therapists, some consider themselves specialists in working with children, some specialize in forensic work, some are recognized for the work they do in domestic violence, some identify with workers compensation related services, and a multitude of other identities, specialties, and areas of emphasis appear. Some MFTs share closer identities with other licensed professions than they do with other marriage and family therapists. We recognize and respect the professional diversity amongst those who have chosen to be marriage and family therapists and strive to represent the diverse interests that make up this unique and dynamic profession.

CAMFT has been publicly criticized by AAMFT and AAMFT-CA for its removal of opposition to the licensure of professional counselors in California. The opposition was removed when amendments were made to accommodate CAMFT’s numerous concerns and CAMFT was convinced that the profession would be adequately trained to provide mental health services in California. It is interesting, however, that the criticisms arose following the LPC’s achievement of licensing laws in 49 states—all states except California. Arguably, the primary reason that the pursuit of licensing of LPCs in California was thwarted for so many years was CAMFT, its many members, and the strong representation of California licensed marriage and family therapists. The opposition in California from AAMFT and AAMFT-CA never surfaced until 2007 and their legislative interest was limited to this single effort—this single piece of legislation.

When we look back many years ago, there were two divisions of AAMFT in California and those two divisions later became one. The Southern California division at that time did not have the staff or financial resources to devote to legislative and regulatory matters, and in an effort to be supportive of CAMFT’s legislative agenda, regularly provided CAMFT with a contribution to assist in CAMFT’s legislative efforts on behalf of the profession. In those days, they were seemingly more aligned with CAMFT and more mutually supportive. In recent years, since the merger of the divisions, CAMFT has approached the division about legislative issues that CAMFT is sponsoring to involve them in joining our efforts—efforts to work together to further the interests of the profession. There has been no willingness or interest in working with CAMFT on these legislative matters. In fact, there has never been so much as a letter of support.

Historically, AAMFT, at the federal level, had no interest in legislative matters. It was actually Richard Leslie at CAMFT who pushed AAMFT, thereby turning the tide on their involvement in federal legislative matters to attempt to advance the MFT profession. They, since those days, have worked on and continue to work on a number of federal issues, like Substance Abuse Professionals in the Department of Transportation, the Veteran’s Administration, and Medicare. Even though CAMFT is a state and not a national association, we offer assistance to AAMFT at the federal level in every way we reasonably can. Our efforts are intended to show unity in working cooperatively with them in the MFT profession’s best interests.

Of late, while involving AAMFT-CA in discussions with the California Department of Corrections and Rehabilitation, we alerted AAMFT-CA to serious concerns about legislation intending to regulate alcoholism and drug abuse counselors. Even though there is a desire on their part to prevent the competition of LPCs in California, even though they already exist in 49 other states, there was no desire to work with us on attempting to correct problems in the proposed alcoholism and drug abuse counselor licensure bill.

According to the AAMFT-CA newsletter, one of the reasons for AAMFT-CA’s opposition to the LPC legislation is the provision that CAMFT and the Society for Clinical Social Work negotiated with the LPCs, which was the opportunity for our professions to be grandparented, for a limited period of time, into this new profession. The grandparenting is a choice for each individual practitioner. It does not diminish, eliminate, or change the practice of marriage and family therapy or the recognition or existence of marriage and family therapists, or for that matter, the social work profession or the practice of clinical social work. It merely gives licensees options— options, we are told, many members wish to take advantage of. To oppose providing options to the existing professions, in the opinion of our leadership, is short-sighted and comes from a position of fear instead of strength.

When this new profession comes into existence in California, as it most assuredly will—the only question is when, we would like to be on record as striving to work cooperatively with the LPC profession and their leadership, as we have tried to do with all of the mental health disciplines, and just as we have tried to do with AAMFT and AAMFTCA.

It is the belief of our leadership that we should not merely try to get along, we need to find ways to be mutually supportive of one another. Mutual support, however, means hard work and time spent discussing issues and being willing to develop a common ground. This type of give and take is what allowed CAMFT and other professional organizations to remove our opposing positions on the LPC legislation. We all reached a point where we each gained something and could feel comfortable about each other’s positions. No one gains by steadfastness, an unwillingness to negotiate, and casting barbs at the perceived opposition. To achieve the greatest success on behalf of the professions we all need to focus on the needs of consumers of mental health services and collectively find ways to assure consumers that mental health treatment is valuable and it works. If consumers are convinced that “it” works, there will not be a sufficient supply of mental health professionals to meet the demand for services. If we can all work together to be successful in this effort, every discipline wins and consequently every mental health professional wins, along with consumers who feel they have been helped.

Mary Riemersma, CAE, former Executive Director. She is available to answer member calls regarding business, legal, and ethical issues.